髓内定位孔骨塞对全膝关节置换术中出血综合控制作用的对照研究

Control study of sealing of intramedullar femoral canal for comprehensive control over intraoperative bleeding in TKA

目的探讨髓内定位孔骨塞对全膝关节置换(TKA)术中出血综合控制作用。方法前瞻性研究自2008-06—2014-03单膝TKA 60例,30例应用髓内定位孔骨塞等综合性措施控制出血(试验组),30例对照组未应用髓内定位孔骨塞法。比较2组手术时间、输血例数、术中出血总量(IBL)、术后第1天总引流量(PWB)、显性失血量(DBL)、预计失血总量(TBVL)、膝关节活动度、VAS评分。结果试验组7例输血,对照组10例输血,试验组输血人数少于对照组,但差异无统计学意义(χ2=0.02,P=0.90)。2组手术时间、IBL、TBVL差异无统计学意义(P>0.05)。试验组术后第1天PWB及DBL小于对照组,差异有统计学意义(P<0.05)。2组入院时、术后第3天、术后第6天、术后第9天以及出院前的膝关节活动度比较差异无统计学意义(P>0.05);2组术后第3天、第6天以及第9天的VAS评分差异也无统计学意义(P>0.05)。结论TKA术中应用髓内定位孔骨塞可以有效降低术后引流量和显性出血量,但需谨慎使用,其远期的影响尚待研究。

Objective To explore the value of sealing of the femoral canal in of total knee arthroplasty.Methods A randomized prospective study that included 60 TKA from Jun.2008 to Mar.2014 divided into two groups（30 in each one,experimental group and control group） was carried out.In the experimental group sealed bone graft sealing was used,while in thecontrol group sealed bone graft sealing was not used.All groups were compared in operation time,number of cases receiving blood transfusion,intraoperative blood loss（IBL）,postoperative wound blood loss（PWB）,dominant blood loss（DBL） and total red blood cell volume loss（TBVL）,knee joint activity,VAS scores.Results In experimental group,7 patients received transfusion therapy and in control group 10 cases.The number of patients receiving transfusion in experimental group was less than the control group,but the difference was not statistically significant（χ^2=0.02,P =0.90）.The difference between two groups in operation time,IBL,TBVL was not statistically significant（P〉0.05）.The PWB and DBL onthe first day after operation of experimental group was less than control group,the difference was statistically significant（P〉0.05）.There were no statistically significant differences between these two groups in the knee joint activity of admission,on the third day,sixth day,ninth day after operation and before discharge（P〈0.05）.There were no statistically significant between these two groups in the VAS score on the third day,sixth day,ninth day after operation.Conclusion The femoral intramedullary guide hole should be plugged with autologous bone because this technique results in a reduction in early blood loss.It can be use in TKA surgery carefully.